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Simple and Straightforward
April 2, 2009 • Volume 9, Issue 13
The Centers for Medicare & Medicaid Services (CMS) took important steps this week toward cleaning up the marketplace for Medicare private health plans. In the 2010 Call Letter, which sets the contract terms for next year, CMS told the insurance companies to consolidate their plan offerings by eliminating plans that have low enrollment or offer substantially similar benefits as other options offered by the same company. CMS is looking for companies to come up with no more than three options for each market, with each option presenting a meaningful difference for the consumer, such as the choice between an HMO and a PPO.
This directive should go a long way toward reducing confusion in the marketplace and clarifying the choices available to consumers. When consumers are frustrated and confused by their coverage choices, they are more likely to give in to the pat answers and high pressure tactics of unscrupulous agents out for a quick buck. Agents who are trying to give their clients affordable, quality coverage will have an easier time identifying and explaining the best coverage options.
Even more importantly, CMS made it clear that plans will no longer be able to design benefits to discriminate against consumers with serious health problems. We hope that means no more benefit packages that begin charging daily copays for care at skilled nursing facilities before the 21st day, which is when Original Medicare starts to assess daily copays.
The agency is pushing all plans to set an annual out-of-pocket limit for ALL medical services of $3,400. We hope that means that plans will no longer be able to advertise an out-of-pocket limit and carve out certain services in the fine print, making enrollees pay unlimited copays for doctor visits or chemotherapy drugs.
The first step in implementing these reforms is a rigorous review of the benefit packages submitted by the plans. The second step will involve simplifying the information consumers receive about benefit packages on medicare.gov, in the Medicare and You handbook and in the marketing materials provided by the plans. For example, consumers should know, without calling the plan or hunting through the fine print, that the plan’s out-of-pocket limit includes all Medicare-covered medical services.
“In order for beneficiaries to have a choice of plans that represent genuine differences, we would expect [Medicare Advantage Organizations] to offer no more than three Medicare Advantage plans by plan type in a market area, and ensure that each plan offered is readily distinguishable from the others based on plan type, benefits offered, access, or other features that permit beneficiaries to choose a health care plan most suitable to their needs.” (2010 Call Letter, Centers for Medicare & Medicaid Services, March 2009)
“Setting more specific minimum benefit standards would help to guarantee consumers adequate coverage regardless of which plan they select. No enrollee would have to worry about making the “wrong” choice and ending up with a plan that provides skimpy benefits or imposes unaffordable out-of-pocket costs for a medical condition that the individual develops during the year.” (Rules of the Road: How an Insurance Exchange can Pool Risk and Protect Enrollees, Center on Budget and Policy Priorities, March 2009)
“The federal government offers some help as beneficiaries navigate their choices, but this help is poorly coordinated and often inadequately executed. Instead of being a role model for the private sector as it could be, Medicare has offered an example of ‘what not to do.’ Hearings in the summer of 2008, for example, included reports of the large number of incorrect answers given to beneficiaries who call the ‘1-800-Medicare’ hotline. Moreover, Medicare has to compete with information provided by private plans that have a stake in placing a positive spin on their own offerings. Medicare expends a large amount of money on providing information but it does not spend those resources wisely.” (Lessons from Medicare for Health Care Reform, Center for American Progress, April 2009)
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Medicare Rights Center’s new Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.
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Submit your story at http://www.medicarerights.org/issues-actions/tell-your-story.php.
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The Louder Our Voice, the Stronger Our Message
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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.
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